Abortion, Poverty, Contraception, and Promiscuity

David Cloutier February 5, 2014 - 12:12pm

There has been much attention given to the latest report that abortions have fallen to their lowest rate in 40 years[1]. The rate of below 17 abortions per 1,000 women ages 15-44 is nearly half of the rate at its peak in 1980. Discussions in the wake of the report have focused on causation, an almost-impossible task given the complexity of the phenomenon of abortion[2]. Isolating causes is certainly not possible, and it seems more reasonable to suggest that more-successful contraception and a more negative public attitude toward the morality of abortion have both contributed to the decline. The question of whether state-level legal restrictions on abortion make any difference is hotly disputed; since these restrictions ordinarily are passed in states where abortions are geographically less available and where the general moral culture is more anti-abortion, it would be hard to know how to separate out these factors.

I want to put these numbers in some larger perspective, by diving more deeply into the statistics about abortion. To me, these raise questions about the level to which one could drive down this abortion rate; as with our economic analysis, a focus on up-or-down trend numbers often obscures the larger phenomenon.

The first issue is the relationship of economic security to abortion. (All data here is taken from Guttmacher’s fact sheets[3] from their last survey.) 69% of abortions are for women at 200% of poverty level or below. The abortion rate for women at or below poverty is 52 per 1,000 women (15-44), but their “unintended birth” rate is also very high: 70 per 1,000. Thus, the “unintended pregnancy” rate for poor women is 137 per 1,000 – a number near six times high than that of 200%+ poverty women (26). Guttmacher actually reports that the higher income group is more likely to choose abortion for an unintended pregnancy… but of course is dramatically less likely to have an unintended pregnancy in the first place. These numbers, which really show dramatic group differences, suggest that poverty and abortion must be addressed together. However, the number do NOT suggest that, if women had more economic resources, they would be more likely to choose life. (Otherwise, we would expect a higher ratio of abortions for poor women.) Rather, they suggest that with economic security, women might be less likely to get pregnant in the first place. Indeed, if women below the poverty level continued to get pregnant at the same rate as currently, but had abortions at the rate of wealthier women, the rate of “unintended births” to those in poverty would be over 100 per 1,000!

The above numbers at least raise pragmatic questions about those whose strategy for addressing the problem is to ask, persuade, or coerce women to keep their babies. However, they also raise questions for the common solution proferred by the other side: contraception is the answer. Guttmacher, a very pro-contraception source, notes that the majority (54%) of women seeking abortions report using it either correctly or incorrectly. Of those not using contraception, Guttmacher reports that “About half of unintended pregnancies occur among the 11% of women who are at risk but are not using contraceptives. Most of these women have practiced contraception in the past.” That last sentence is significant; it calls into question the extent to which education and access are really the issue. Guttmacher even tries to determine reasons why women were not using contraception, and a mix of reasons follow, including “unplanned sex” and a perception of “low risk.” What Guttmacher doesn’t ask is how often this is a case of an unintended pregnancy in a non-stable relationship situation. They do report significantly (without poverty numbers): “More than one in 10 single men indicated that they did not know about the pregnancy until after the child was born. Among single men aware of the pregnancy, nearly three out of four births were reported as unintended.” If abortion is strongly connected to the unintended pregnancy rate, and unintended pregnancies are far more frequently reported by in situations of singleness, then perhaps monogamy matters. The question for the contraception side is how you drive down the “unintended pregnancy” rate in light of risky sexual behavior. As they note, the trend for “unintended pregnancy” among poor women is not downward – anything but! In 1994, the unintended pregnancy rate among women with incomes below the federal poverty line was 88 per 1,000 women aged 15–44; it rose to 120 in 2001 and 137 in 2008—a 56% increase since 1994. At the same time, the rate among higher –income women (those with incomes at or above 200% of the poverty line) fell from 34 in 1994 to 28 in 2001 and 26 in 2008—a 24% decrease.” Even if you increase effective contraception use, an increase in risky sexual behaviors will potentially offset this. The key number that would be helpful to know would be the abortion rate for women whose pregnancies – intended or not – occur in a stable, monogamous relationship. (Aside: the point here is not to throw stones. A public conversation about why we have difficult achieving monogamous relationships even when the vast majority of people desire them would also be helpful. We should be able to have a conversation about the problems of promiscuity without it simply be a stone-throwing contest, just as we can have conversations about the problems of drug use while not simply scapegoating individuals.)

The third issue to raise is the question of the long-term goal. Let’s say we have a system of effective contraception access and use, more comprehensive health care, somewhat higher restrictions on abortion availability – where will that get us? This is a description perhaps not far from the situation in Western Europe[4] or (excepting the legal restrictions) among higher-income American women. Western Europe has the lowest abortion rate of any region in the world (about 12 per 1,000) and Guttmacher’s numbers suggest an abortion rate of about 14 per 1,000 for higher-income women. If we consider these numbers a kind of ideal-condition floor, let’s say the overall abortion rate dropped to 14 or even 12 in the U.S. – a stuation where we would have between 600,000 and 800,000 abortions every year. It would be hard for anyone to suggest that we had reached a point where abortion is “rare” with these kinds of numbers. I’m not sure what proposals pro-contraception-availability advocates have to lower the rate any further than this. I suppose “long-acting” birth-control methods, which reduce error rates, are the key ones. However, I think this is also a situation where we again have to talk about sexual behavior and say that avoiding risky – and perhaps the better term is “promiscuous” – sexual behaviors is a necessary and reasonable part of reducing abortions and even unintended pregnancies.

One way to consider a mature, reasonable public conversation on this issue would be for Catholics, while not requiring any change in magisterial teaching, to admit that it is plausible in a pluralistic society to view contraception as a legitimate public health and welfare issue. Insofar as Catholic tolerate legal contraception availability (which it seems we do) and do not attempt to criminalize officially immoral sexual behaviors (which we do not), there is a space for real conversation. One might here consider the "gradualism" indicated in Pope Benedict's well-know remarks in his Light of the World interview. But correspondingly, folks like the Guttmacher Institute could admit that public discouragement of promiscuous sexual behavior should be a necessary part of their aim to reduce unintended pregnancies. There are many corresponding cases where social changes in behavior really do happen by strong discouragement. Publicly discouraging promiscuity is at least as important as, say, public discouraging of tobacco use, and just as the glamorization of tobacco use in movies was subject to very strong backlash, so too might the same be done in popular culture for promiscuous sexual behavior. To make another comparison, the glamorization of promiscuity can be criticized with the same weight given to those who speak out against denigrating media portrayals of women and African-Americans – like these, it is not a matter of passing laws but of changing what we deem as acceptable. A bridge-building conversation would be one where we had both, not just one or the other.